Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Jeffrey A. Burr

Second Advisor

Elizabeth Dugan

Third Advisor

David Gagnon


Falls are related to increased risks of morbidity, disability, and mortality in older adults. Research consistently finds an association between late-life depression and falls. Most research focuses on biomedical explanations, but little is known about the social determinants of falls. Specifically, how social relationships are related to falls and how they can modify the association between depression and falls. To address this gap, this study investigated the relationships between depression, social factors, and falls. Data from the Health and Retirement Study were examined and included community dwelling participants aged 65+ years (N=8464). The main outcome was number of falls reported in 2008, 2010, and 2012. Independent variables included social factors, depression and covariates reported in 2006, 2008, and 2010. Generalized Estimating Equation (GEE) for negative binomial regression adjusted for repeated measures was performed to estimate the association between independent variables (depression or social support) and falls in in this study. Results showed that 38% of older adults experienced at least one fall during each two-year period. About 21% of participants were depressed in 2006. The mean social relationship index (indicators included living with spouse/partner, having friends and relatives in their neighborhood, social support, religious service attendance, and formal volunteering) was 3.3 ±1.3 (range 0-6) in 2006. Regression models indicated the rate of experiencing a fall increased by 21% among participants who were depressed (IRR=1.21, 95% CI=1.12-1.31). The overall social relationship index was associated with a 3% reduction in the rate of falls (IRR=0.97, 95% CI=0.95-1.00). Having good friends in the neighborhood reduced the association between depression and falls by 20% compared to not having good friends. Similarly, having children reduced the association between depression and falls by 29%. A higher social relationship index, having good friends in the neighborhood and having children may be an asset when designing fall prevention programs. A new avenue of potential intervention has been identified to reduce falls; fall prevention efforts should consider the role of social relationships and social activities, especially for adults who may be depressed.


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